Public-private migrations of anaesthesiologists: time to act

Abstract

The anaesthesiology workforce in South Africa (SA) and other low- to middle-income countries (LMICs) falls significantly below the density of at least ten anaesthesiologists per 100 000 population, recommended by the World Federation of Societies of Anaesthesiologists.¹ In 2024, the number of registered anaesthesiologists on the Health Professions Council register stood at 2 074, giving the anaesthesiologists-to-population density of three per 100 000.² This figure is the country’s overall density, with even lower densities in the rural provinces, as Tiwari et al.³ reported. The ratio needs further interrogation concerning the distribution of anaesthesiologists between the public and private sectors in SA to understand its true significance. The South African Society of Anaesthesiologists, whose members are the majority of practising anaesthesiologists in SA, reports an 80:20 split in the private practitioner membership, with roughly 80% of anaesthesiologists working in the private sector.⁴ It is of concern that the 80% working in the private sector serve about 16% of the SA population. This maldistribution of the anaesthesiology workforce will likely narrow access to care and widen inequalities. This will adversely affect achieving sustainable development goals 3 and 10, which promote health and equality for all.⁵ This gives impetus to understanding the factors influencing anaesthesiology migration from the public to the private sector.